Health Care Laws Directly Impacting Employer Costs
Chapter 224 of the Acts of 2012: establishment of cost growth benchmark and HPC/CHIA
Chapter 115 of the Acts of 2016: Price variation commission – recommendations were not implemented
Chapter 41 of the Acts of 2019: MassHealth direct negotiation/HPC drug pricing review/retro denials
H.4620: An Act Enhancing the Market Review Process reported out favorably by the House Ways and Means Committee on May 2, 2024.
Legislation adding cost since chapter 58
Mandates
~$2.47 billion in premium costs
- Hearing aids
- Licensed marriage and family therapists
- Oral cancer therapy
- 14 days coverage of inpatient SUD services without medical management
- Lyme disease
- HIV associated lipodystrophy syndrome treatment mandate
- Out of Network, PANDA/PANS telehealth
- Abortion mandate, elimination of cost-sharing for abortion and abortion related care
- Mental health wellness exam
- Coverage for disabled dependents mandate
- PreP Coverage Mandate
Assessments
~$3.1 billion in assessments on payers from 2013 – 2023
- Assessment on surcharge payers to fund HPC and CHIA
- Assessment on surcharge payers to fund Vaccine Purchase Trust Fund
- MCPAP assessment
- Behavioral Health Trust Fund and Behavioral Health Advisory Commission
- BH Assessment on Payers
Limits on Health Plan Tools
- Mandates 14 days coverage of CSS without medical management
- Limits health plans and pharmacy benefit managers’ ability to audit pharmacies
- Behavioral Health – elimination of PA for acute inpatient, CBAT, ICBAT, changes to OPP regulations re: MN decisions
- Limitations on Retroactive denials
- Limitations on step therapy
